Perioperative outcomes of craniosynostosis: Experience of a newly established national reference center for pediatric craniofacial surgery.

Abstract

High annual surgical caseloads have been considered essential for patient safety in craniosynostosis care. We evaluated perioperative outcomes over the first 12 years of experience in a national reference center for pediatric craniofacial surgery-a period characterized by a gradual increase in surgical volume. All transcranial surgeries for craniosynostosis between 2012 and 2023 were included. Data were obtained from a local quality registry and electronic medical records. Perioperative complications, adverse events, and outlier outcomes occurring within 30 days postoperatively were recorded, categorized, and graded according to the Oxford Grading Scale (OGS). Bench-marking was performed using historical data from the Pediatric Craniofacial Collaborative Group (PCCG). Univariate and multivariate regression were used to analyze explanatory factors to complications and adverse events. A total of 322 transcranial craniosynostosis surgeries were performed with an overall complication rate of 6.8%. There were no severe complications of Grade 4 or 5% and 68% (15/22) of all complications were OGS Grade 1. Outcomes compared favorably with the PCCG benchmark data. Higher complication rates were observed in patients with craniofacial syndromes and surgical complications were more frequent in calvarial remodeling procedures compared to less invasive surgeries. The overall complication rate was low and compared favorably with previously published results, including those from centers with longer experience and higher surgical volumes. These findings suggest that safe and effective craniosynostosis care can be achieved during the buildup phase of a specialized center, provided robust multidisciplinary structures and protocols are in place.